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OAS MeetingInnovations in Avian Influenza Preparedness

November 14, 2007Washington DC

Pan AmericanHealthOrganization

Avian and Human Pandemic Influenza: Addressing the Need for Integration

between Health and Agriculture in the Preparedness Plans in Latin America

Cristina Schneider *, Anne Roca **, César Falconi **, Albino Belotto *, Andre Medici **

* PAHO – Veterinary Public Health Unit/ Health Surveillance and Disease Management

** IADB - Rural Development Unit/ Sustainable Development Department


Acknowledgements:

Collaboration of the countries’ health and agriculture representatives in the Influenza Seminars, the USAID, IICA, FAO, and OIRSA

Study link: http://www.iadb.org/sds/doc/rur-avianandhumanpandemicinfluenza.pdf


The link between animal and human health

• Of the 1,415 known human pathogens, 61% are zoonotic• 75% of emerging human diseases are zoonotic

– BSE and vCJD– SARS– Avian Influenza A/(H5N1)– Rabies– Ebola– Monkeypox

An infection from bite on the finger from a prairie dog -suspected as the monkeypox carrier. Photos: AFP and Reuters

SARS epidemic 2003



• Factors affecting increases in zoonotic disease– Contact with wildlife– Environmental

changes– Globalization– Microbiological

adaptationPhoto: PAHO



• Economic impact– Livestock disease

outbreaks around the world have cost the ~$80 billion since 1990

Sheep disposal in UK to control Foot and Mouth Disease outbreak


Avian Influenza - The current threat

• Avian Influenza A H5N1– Severe illness in domestic poultry– Extremely contagious

• The most at risk – poultry workers backyard farmers• Human health

www.medical-definitions.net



Economic impact • Global

– Since 2003 • >220 million poultry dead/destroyed• > 5, 000 outbreaks of H5N1

– Economic losses estimated at $10 billion

Photo: PAHO


Avian Influenza - The current threatEconomic impact • Region (FAO estimations for 2005)

– Americas were responsible for the production of 43% of the 84 billion tons of poultry produced worldwide

– Americas largest poultry exporting region in the World (57% of 10.4 billion tons)

– 5 countries were responsible for 99% of total exports (USA, Brazil, Canada, Argentina, and Chile)


– Spread from migratory waterfowl to domestic poultry

– Control measures have failed to prevent economic, animal, and human losses



Actors in preparedness to a possible pandemic

– At the global level

• WHO• FAO• OIE• Others UN agencies

• Global Frameworks (GF-TADs; GLEWS)


Actors in preparedness to a possible pandemic

– At the regional level

• FAO Regional Office• OIE Regional Office• PAHO (PANAFTOSA)• IICA• OIRSA

• The Inter-American Meeting, at the Ministerial Level, on Health and Agriculture (RIMSA)


Importance of intersectoral action

• It is clear that to protect humans from Avian Influenza, the disease must be controlled at the source of the infection: in poultry

Photo: PAHO



• Strengthen the interface between human and animal health to prevent zoonosis:

– Surveillance across sectors (early detection, and notification are necessary for effective control programs)

– Biosecurity (in this case, ensuring that animals and human food supplies linked to them are protected)

– Biosafety (in this case, ensuring the protection of people in contact with the virus)

– Adequate public information (relying on scientific facts, to communicate risks and avoid a related economic crisis)


Animal Health

Human Health

Zoonosis


To adequately address the complex process through which a zoonosis emerges and protect the population against these diseases, health and agriculture sectors must work in an integrated way.


Objectives of this study

Highlight the importance of and evaluate the integration between the health and agriculture sectors in preparedness plans in Latin American countries


Methodology of this study• Integration was evaluated through ten questions submitted

to representatives of the sectors in the countries of the Region during a series of subregional workshops. The answers were analyzed by subregion.

• The percentage of integration was estimated and contrasted with demographic, socioeconomic and health data and by category of activity.

• Countries included in evaluation– All Southern Cone, Andean Area and Central America

countries – Latin Caribbean – Cuba, Dominican Republic, Haiti


Methodology of this study• Example of questions used to evaluate response level

– Are health, agriculture and other sectors included in the preparedness plan?

– Is there a mechanism for routine exchange of epidemiological information related to influenza among the health and agriculture sectors?

– Would the people investigating an outbreak and carrying out the actions recommended by FAO/OIE have the personal protection equipments (PPE) recommended by WHO?


•Southern Cone, with major poultry production and export, enjoys high levels of integration of the health and agriculture sectors.

•Central America shows the least integration and is the subregion with the most rural population, most population under the poverty line, and highest percentage of workers in the agricultural sector.

•This seems to indicate that the population of Central America could be strongly affected in case of an outbreak of avian influenza in poultry.

Results

0

10

20

30

40

50

60

70

80

Southern Cone Andean Area Central America Latin Caribbean(Cuba, Haiti, Rep.

Dom.)

Total

Leve

l of i

nteg

ratio

n he

alth

/agr

icul

ture

(%)

Figure 1. Level of integration of the health and agriculture sectors in preparedness plans, as reflected in the 10 questions selected


All subregions presented good coordination between the health and agriculture sectors in the preparedness plans, however preparations for a joint intersectoral response to an outbreak and information exchange need to be improved.

Figure 2. Positive responses by category of activity, by subregion and for the regional sample as a whole

0

20

40

60

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Southern Cone Central America Andean Area Latin Caribbean Total

%

Intersectoral coordination

Information exchange

Outbreak intervention

Results


•The current crisis, because of its pandemic potential and its economic impact, provides an opportunity to bring together all involved sectors and preparing to any zoonotic threat

Recommendations

Photos: UNICEF


• Could be suggested five categories of needs to address the problem of integration in the Region:

a) Integration polices (Ex. RIMSA)

b) Financial aspects (Ex. IICA/PAHO strategic fund for emergent problems)

c) Training (Ex. intersectoral response teams)

d) Access to data and information dissemination (Ex. Inter agencies portal)

e) Interdisciplinary studies

Recommendations


Thank you for your attention

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